Holly Help Special Gifts Order Form
(please print clearly)
Your Name: _______________________________________________________
Your Telephone Number (s):__________________________________________
Your Address: _____________________________________________________
Memorials: Gift Of Life Bequest
In Memory Of: (name)___________________ (pet) ____ (person)_____
Family To Receive Memorial Certificate: (name) ___________________
(mailing address) _____________________________________________
Amount Enclosed: ________________________________________________
Honorariums & Gifts In Honor Of
In Honor Of: (name) ____________________ (pet) ____ (person)_____
Person To Receive Honorarium Certificate: (name)_________________
(mailing address) _____________________________________________
If not Honorarium, list reason for gift: (birthday)__________________
(anniversary)______ (Christmas)__________ (other)_______________
Amount Enclosed: ________________________________________________
Surgery Sponsorship:
Sponsorship preferred for (dog ) _____ (cat) ______ (either) _____
Amount Enclosed: ____________________________________________
'Thank You For Your Generosity)
Please make your check payable to Ferguson Animal Hospital.
Enclose check and completed order form and mail to:
HOLLY HELP SPECIAL GIFTS
C/O Sue Williams
PO Box l264
Bristol, Va.
24203